Baby girl's cancer detected in chance discovery

Savannah Montoya, 4 months, is held by her father, Samuel Montoya, as her mother, Shenandoah Stevens, watches Tuesday at the El Paso Children's Hospital.

EL PASO, Texas - As families across the United States gather to celebrate Thanksgiving, a young El Paso couple will be extra grateful.

"This is going to be a great Thanksgiving," said Sam Montoya. "We have lots to be thankful for."

The top item on that list is the health of Savannah, his 4-month-old daughter, who was born with a malignant tumor in her adrenal glands just above the right kidney.

Savannah was born July 21 with neuroblastoma, a cancerous tumor that develops in the tissue of the adrenal glands, which sit on top of the kidneys and produce hormones responsible for controlling heart rate, blood pressure and other important functions.

Neuroblastoma, which usually occurs in infants and children, can spread to other parts of the body such as the lymph nodes, skin, liver and bones.
"When I heard she had it, I was devastated," Montoya said. "I didn't know what it meant at the time; I just felt really sad."

Shenandoah Stevens, Savannah's mother, took her in for a regular checkup two months ago when the pediatrician noticed Savannah had a slight malformation on her left earlobe.

"The ears form together with the kidneys, and since there was a malformation in her ear, she wanted an ultrasound done on her kidneys to make sure there was nothing wrong," Stevens said. "She sent me to Providence to get the ultrasound done. When I went in for the results, she told me there was a mass on her right kidney and I had to go to a specialist."

Montoya and Stevens took their baby girl to El Paso Children's Hospital to see Dr.

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William Spurbeck, a pediatric general surgeon, and Dr. Arlynn Mulne, a pediatric hematology-oncology specialist.

After an extended exam at El Paso Children's Hospital, it was determined the tumor was not on the kidney, but just above it on the adrenal gland.
The best course of action was to perform a laparoscopic adrenalectomy, in which a 5-millimeter incision was made in Savannah's stomach, with three more 3-millimeter incisions in her side, to reach and remove the tumor.

"I didn't think it was going to be that serious," Stevens said. "I didn't expect her to have to go through surgery. I was expecting her to be put under some sort of medication, but not surgery."

The surgery took a little less than two hours.

Neuroblastoma occurs when neuroblasts grow and divide uncontrollably instead of developing into nerve cells. The exact cause of this abnormal growth is unknown, but scientists believe it's related to a defect in the genes of a neuroblast that allows it to divide uncontrollably.

"It was fortuitous that her parents took her in and got the ultrasound and were able to find it, because it was localized only to the adrenal gland and had not spread anywhere else," said Spurbeck, who is also an assistant professor for the Department of Surgery at Texas Tech University Health Sciences Center. "We were able to take the entire tumor out without having to do a major laparotomy."

Spurbeck said neuroblastoma usually derives from some form of neurological tissue found in the adrenal glands.

"The earlier the diagnoses, the better," he said. "There is a lot on how these tumors behave, but age and diagnosis, the tumor biology -- after they look at it under a microscope -- has a lot to do with its prognosis. But a baby that's 2 months old usually has a favorable prognosis. The fact that they were able to find it early and it was isolated just to the adrenal gland, all fall into her favor."

Mulne, who is also an associate professor for the Department of Pediatrics at Texas Tech University Health Sciences Center, said neuroblastoma is the most common solid tumor she sees in children.

"The younger children (like Savannah with a neuroblastoma) are a little bit less common," she said. "The main key to their prognosis is surgery. All of her biologic characteristics of the tumor are also favorable, so hopefully we don't have to do any further therapy at all."

Mulne said the chance of the tumor not returning is 90 percent.

"If parents take their children to their regular routine exams, their physician will be looking for signs. But any kind of abdominal distention would probably be one of the few things parents might notice, including persistent diarrhea," she said.

Sam Montoya, Savannah's father, is glad they found the tumor early enough.

"Once we went through surgery, we were hoping everything would turn out fine, which it did," he said. "I'm just happy and relieved that she was OK and we'll be celebrating Thanksgiving together."

Victor R. Martinez can be reached at vmartinez@elpasotimes.com; follow him on Twitter @vrmart.

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